OBJECTIVES: A me-too list has been implemented in a German KV (regional association of SHI-accredited physicians) with the intention of promoting cost-effective prescribing behavior. The aim was to investigate whether the me-too list is an effective steering tool. A mometasone-containing nasal spray (MHN) which has been listed as a me-too, should be substituted by budesonide-containing nasal sprays (BHN), because MHN therapy is assumed to be equally effective but more cost intensive than BHN. MHN's market share has declined after listing. METHODS: A retrospective study of anonymized patient data was conducted from March to April 2009 in KV North Rhine. ENT physicians documented patients which had received MHN for minimum 12 months and who had then been switched to another intranasal steroid (INS). Evaluation was done with descriptive statistics. RESULTS: A total of 676 patients documented by 76 physicians were eligible for the analysis. A total of 189 patients (28%) received MHN only; a switch to other INS was documented for 487 patients (72%). ENTs cited economic reasons for changing the INS in 86.4% of the cases. Compared to other INS, the average number of consultations for MHN treatment and the administered dose of MHN, regardless of diagnosis, were lower, MHN patients required refill prescriptions later, less co medication, and MHN generated lower daily treatment costs in real-life. CONCLUSIONS: Reasons for switching from MHN were economically. Therefore the me-too list has a heavy impact on prescription behavior. Daily treatment costs of MHN were lower in real-life. Analysis based on PDD (prescribed daily doses) showed that the economic effect of switching a patient to another INS was far less than expected. For instance it was offset by a higher number of consultations in association with the cheaper alternatives in more frequent use. An economic evaluation with a precise quantification would be of major interest in future.